Out-of-Pocket Maximum Refunds Get Your Medical Bills Back /Korea out-of-pocket maximum refund
The fastest way to get money back on medical bills in Korea is the out-of-pocket maximum refund. For 2023 services, the National Health Insurance Service (NHIS) will refund a total of KRW 2.792 trillion to 2,135,776 members—an average of about KRW 1.31 million per person. Payout procedures begin on August 28 after NHIS finalized each person’s annual cap. This guide focuses on one thing: how to make sure you get your refund—who qualifies, how much, and how to apply right now.
Refund at a glance: what it is, who gets it
What’s refunded? If your annual covered out-of-pocket payments (patient’s share for NHI-covered services) exceed your personal cap, NHIS refunds 100% of the excess. The 2024 cap range (used to set personal caps) is KRW 870,000–10,500,000 depending on income tier.
Who’s getting paid for 2023? 2,135,776 members will receive refunds totaling KRW 2.792 trillion (avg. KRW 1.31 million).
Who benefits most? The bottom 50% by income account for 89% of recipients and 76.5% of the refund amount (KRW 2.1352 trillion). Seniors 65+: 1,211,616 recipients, KRW 1.844 trillion paid (56.7% of people, 66% of funds).
What’s excluded? Non-covered items (non-benefits), selective benefits, and fully self-paid services are not counted toward the cap—so they are not refunded.
Claim your refund in 3 steps
Check your notice — Starting Aug 28, NHIS sends a refund notice + application (mail/SMS/app) to eligible members.
Apply quickly — Use any channel below:
· Website: nhis.or.kr
· Mobile app: The건강보험
· Call center: 1577-1000
· Fax / Mail / In-person at your NHIS branchConfirm deposit — After review, NHIS transfers your excess amount to your own bank account. Track status via the notice or the channels above.
How much will I get? (quick examples)
If your annual covered out-of-pocket total was KRW 2.5 million and your personal cap was KRW 1.2 million → you get a KRW 1.3 million refund (the entire excess).
Your cap depends on your income tier; NHIS calculates it for each person and lists it in your notice.
Tip: The key number is the yearly sum of “patient’s share for covered services” on your hospital/pharmacy receipts. Non-covered amounts are excluded from the refund math.
Application checklist (so nothing delays your money)
ID and your NHIS notice (if received).
Bank info — Your own-name account number.
Applying by proxy? Prepare a power of attorney and family relation docs if required; confirm details with your local branch.
Choose the fastest channel — website / app / 1577-1000 / branch visit.
Who should prioritize applying?
Lower-income half of households — 89% of all recipients; 76.5% of total refunds.
Seniors (65+) — More than half of recipients and two-thirds of payouts.
Long-term, high-cost treatment (e.g., chronic, rare, or severe conditions) — once covered costs push you over the cap, the refund meaningfully reduces real expenses.
FAQ
1) I didn’t get a notice. Could I still be eligible?
Yes. Contact NHIS (nhis.or.kr / 1577-1000 / app) to check eligibility and apply proactively.
2) Are non-covered items (e.g., some tests, private rooms) refunded?
No. The cap and refund apply only to NHI-covered patient shares. Non-covered / selective benefits / fully self-paid items are excluded.
3) Can a family member receive my refund?
Yes, via proxy application. Bring a power of attorney and ID; ask your NHIS branch which documents they require.
4) When will the money arrive?
It follows the sequence application → review → payment. Track progress using the contact info in your notice or by calling 1577-1000.
5) Will I get a refund for 2024 bills?
Yes. NHIS finalizes each year’s personal caps and then processes the prior year’s refunds the following year.
One-line takeaway
“If your 2023 covered out-of-pocket payments exceeded your personal cap, NHIS refunds the entire excess.” From Aug 28, apply online, by app, phone, mail, or in person—don’t leave an average KRW 1.31 million on the table.
Official contacts
• National Health Insurance Service (NHIS): nhis.or.kr / Call center 1577-1000
• Ministry of Health and Welfare: mohw.go.kr
Note: This article reframes the government announcement with a refund-first focus. Your exact cap, eligibility, and documentation are determined by NHIS; follow your personal notice and branch guidance.
